The substrate specificity of thrombin is regulated by binding of macromolecular substrates and effectors to exosites I and II. Exosites I and II have been reported to be extremely linked allosterically, such that binding of a ligand to one exosite results in near-total loss of affinity for ligands at the alternative exosite, whereas other studies support the independence of the interactions. The specificity of thrombin toward its procoagulant and anticoagulant physiological substrates is allosterically regulated by interactions of macromolecular substrates, inhibitors, and effectors with either of two electropositive sites, exosites I and II, in near-opposition on the enzyme surface (1, 2). Exosite I binds fibrinogen (Fbg) 1 (3), fibrin I and II (3, 4), the 12-residue carboxyl-terminal hirudin 54 -65 sequence (5, 6), thrombomodulin (7), the thrombin receptor (8, 9), and an acidic sequence on the serpin, heparin cofactor II (10, 11). Exosite II binds heparin and other glycosaminoglycans (2, 12, 13), prothrombin activation fragment 2 (F2) (14), the chondroitin sulfate moiety of thrombomodulin (15, 16), the leech peptide hemadin (17), and an exosite II-specific human monoclonal antibody (18). Factors V (19 -22), Va (21,22), and VIII (19), platelet glycoprotein Ib␣ (23-25), and the snake venom protein bothrojaracin (26) have been reported to interact with both exosites I and II.Binding of exosite ligands to thrombin is correlated with significant changes in the kinetics of hydrolysis of peptide ester and peptide p-nitroanilide substrates (3,7,9,18,(27)(28)(29)(30)(31) in addition to profound effects on specificity and reactivity toward its natural macromolecular substrates and inhibitors (10,11,15,(32)(33)(34)(35)(36). These studies indicate that exosite binding of allosteric effectors is coupled to conformational changes affecting the S1-S3 substrate specificity subsites in the thrombin catalytic site (37-39). Binding studies of F2, thrombomodulin, fibrin, and heparin with various active site-labeled thrombin derivatives in which the S1-S4 subsites were occupied (16,34,40), and studies of the effect of exosite ligand binding on the hydrolysis of tripeptide p-nitroanilide substrates suggest that structurally different ligands produce ligand-specific changes in the catalytic site. Extreme allosteric linkage between exosites I and II (30,31,41) has been reported to prevent simultaneous occupation of exosites I and II (30,41), whereas other studies provide contrasting evidence for binary and ternary complex formation with similar affinities among thrombin and exosite I and II ligands (18). In favor of inter-exosite linkage, the dissociation constant for fluorescently labeled, Tyr 63 -sulfated hirudin [53][54][55][56][57][58][59][60][61][62][63][64] and bovine thrombin was weakened 10-fold by F2 binding, although ternary complex formation was demonstrated (31). Extremely negative interexosite interactions were reported for Tyr 63 -sulfated hirudin 54 -65 (Hir 54 -65 (SO 3 Ϫ )) and human F2 or a synthetic peptide...